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Leading Off: The AAHA diabetes management guidelines: An inside look

Managing diabetes mellitus in dogs and cats presents some unique challenges. Although a wealth of literature exists on the subject, treatment plans must be tailored for each patient, and the response to therapy is sometimes unpredictable. Undoubtedly, caring for diabetic veterinary patients requires a blend of art and science.

In the fall of 2009, the American Animal Hospital Association (AAHA) brought together six small-animal clinicians, including three internists, a feline clinician, and two general practitioners. We were asked to create guidelines regarding the diagnosis, initial treatment, and long-term management of diabetes mellitus in both dogs and cats. These guidelines had to be clinically applicable and immediately relevant to small-animal practitioners, and any recommendations had to be supported—if possible—by peer-reviewed literature rather than opinion or anecdote. In addition, detailed information was required regarding patient evaluation and monitoring, along with insulin selection and dosing decisions. (See the sidebar "What the guidelines cover".)

What the guidelines cover

Successful management of a diabetic dog or cat cannot be achieved with a one-size-fits-all approach, and we were conscious of the limitations inherent in creating guidelines for such a complex disease. However, we hoped to provide a sound foundation on which safe and appropriate clinical decisions can be made. The goal was to demystify this disorder and provide the information practitioners need to approach diabetic patients with confidence. These guidelines are not intended to define the standard of care for diabetic dogs and cats, and we realize many effective approaches exist for managing these patients.

Achieving consensus on any medical issue is difficult. Achieving consensus between six seasoned clinicians with experience in general practice, referral practice, institutional practice, teaching, and research has its own set of challenges. However, we listened and learned from each other and created a document we think has real clinical value. We hope it will help veterinary practitioners in the routine care and management of diabetic dogs and cats and provide a framework for continued learning.